The document provides guidance on performing and interpreting 12-lead electrocardiograms (ECGs). It outlines the proper procedure for applying electrodes, including skin preparation and placement of limb and chest leads. Key aspects that must be checked include verifying the leads are attached correctly, the ECG is free of artifact, and identifying any critical findings such as arrhythmias or ST segment changes. Interpreting the ECG requires evaluating the rhythm, measuring the heart rate, identifying normal and abnormal waveforms, and relating findings to the patient's condition.
crème de la crème basics to understand electrocardiographic analysis in an easy & simple way with some specifications to its use in Emergency medicine/clinical toxicology practice.
crème de la crème basics to understand electrocardiographic analysis in an easy & simple way with some specifications to its use in Emergency medicine/clinical toxicology practice.
Salient features of the book are -
- The book provides a shortcut to understand and remember certain specific formulae and points you require to interpret the 12-lead ECG.
- Treatment protocols (in green boxes) for most of the important conditions are also included.
- View sample ECGs as you read along the topics.
- The content is explained in a very simple language to provide good conceptions, written from a student’s point of view.
- People can gain their belief in the book after going through sample ECGs which would be available at www.themedicalpost.net/ecg
- The book competes with the other books available in the market in simplicity, summaries, treatment protocols, live diagrams and regularly updated sample ECGs on the website.
A great tutorial from Dr Alistair Jones NHS medical educator (http://www.yorkshiremedicaleducation.co.uk/about-us) on ECG syndromes. Beyond the basics (but essential knowledge for training emergency physicians)
Salient features of the book are -
- The book provides a shortcut to understand and remember certain specific formulae and points you require to interpret the 12-lead ECG.
- Treatment protocols (in green boxes) for most of the important conditions are also included.
- View sample ECGs as you read along the topics.
- The content is explained in a very simple language to provide good conceptions, written from a student’s point of view.
- People can gain their belief in the book after going through sample ECGs which would be available at www.themedicalpost.net/ecg
- The book competes with the other books available in the market in simplicity, summaries, treatment protocols, live diagrams and regularly updated sample ECGs on the website.
A great tutorial from Dr Alistair Jones NHS medical educator (http://www.yorkshiremedicaleducation.co.uk/about-us) on ECG syndromes. Beyond the basics (but essential knowledge for training emergency physicians)
Electrocardiography is the non-invasive diagnostic test in cardiology recording electrical changes in the heart and helps to the diagnosis and management of patients with cardiac disorders. An electrocardiogram depicts the series of waves that relate to the electrical impulses which occur during each beat of the heart.
Classification and Detection of ECG-signals using Artificial Neural NetworksGaurav upadhyay
Electrocardiogram (ECG), a noninvasive technique is used as a primary diagnostic tool for
cardiovascular diseases. A cleaned ECG signal provides necessary information about the
electrophysiology of the heart diseases and ischemic changes that may occur. It provides
valuable information about the functional aspects of the heart and cardiovascular system. The
objective of the thesis is to automatic detection of cardiac arrhythmias in ECG signal.
Recently developed digital signal processing and pattern reorganization technique is used in
this thesis for detection of cardiac arrhythmias. The detection of cardiac arrhythmias in the
ECG signal consists of following stages: detection of QRS complex in ECG signal; feature
extraction from detected QRS complexes; classification of beats using extracted feature set
from QRS complexes. In turn automatic classification of heartbeats represents the automatic
detection of cardiac arrhythmias in ECG signal. Hence, in this thesis, we developed the
automatic algorithms for classification of heartbeats to detect cardiac arrhythmias in ECG
signal.QRS complex detection is the first step towards automatic detection of cardiac
arrhythmias in ECG signal. A novel algorithm for accurate detection of QRS complex in ECG
signal peak classification approach is used in ECG signal for determining various diseases . As
known the amplitudes and duration values of P-Q-R-S-T peaks determine the functioning of
heart of human. Therefore duration and amplitude of all peaks are found. R-R and P-R
intervals are calculated. Finally, we have obtained the necessary information for disease
detection .For detection of cardiac arrhythmias; the extracted features in the ECG signal will
be input to the classifier. The extracted features contain morphological l features of each
heartbeat in the ECG signal. This project is implemented by using MATLAB software. An
interface was created to easily select and process the signal. “.dat” format is used the for ECG
signal data. We have detected bradycardia and tachycardia. Massachusetts Institute of
Technology Beth Israel Hospital (MIT-BIH) arrhythmias database has been used for
performance analysis.
learn how to obtain an ECG, anyone can do it:
This presentation aims to show the clinical process of obtaining an ECG and features some tips and suggestions to troubleshoot and improve the quality of the tracing.
Please note that you're welcome to use any slides as long as you reference my post when you do so to maintain the integrity of authorship
If interested in detailed answers, please email: aamirdash@yahoo.com
Thanks, Ahmad
Case-1: ECG with NSR
Case-2: ECG with sinus bradycardia
Case-3: ECG with sinus tachycardia
Case-4: ECG with sinus arrhythmia
Determining heart rate
Normal heart rate in adults
Normal heart rate in children
Characteristics of NSR
Factors that can change heart rate
Variations on sinus rhythm
Sinus arrhythmia
Sinus bradycardia
Sinus tachycardia
INAPPROPRIATE SINUS Tachycardia
commonly used for medical students, and helpful to use this ppt to study for them, and also a common man can understand very easily what is coarctation of aorta.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
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QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
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One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
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2. Upon completion one will be
able to:
Describe what an ECG is.
Describe the proper hook-up procedure for a 12-Lead
ECG
Identify basic normal ECG waveform morphology.
Distinguish between basic ECG arrhythmia and artifact.
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON
MANGALORE. PH:+919496743672
4. THE CONDUCTINGY SYSTEM
SA Node
Inter-nodal pathway
AV Node
Bundle of HIS
Bundle Branches
Purkinje Fibers
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON
MANGALORE. PH:+919496743672
7. 12 LEAD ECG
Learning objectives:
Describe the correct
placement of all electrodes
Proper Skin preparation
Care of the ECG machine, wires and electrodes
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
8. Principles of Electrocardiograph
Electrocardiograph – is the instrument that records the
electrical activity of the heart
Electrocardiogram (ECG) is the record of that activity
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
9. HOOKING UP THE
12-LEAD ECG
Proper skin prep
Placement of the limb electrodes
Placement of the chest electrodes
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
14. LETS REVIEW
What is an ECG
What are the limb leads?
What are the chest leads?
Why do skin prep?
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
16. INFORMATION ON THE ECG
Patients demographics
Heart rate and measurements
Speed ECG is recorded at
Voltage ECG is recorded at
What the filter is set on
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
17. INFORMATION ON THE 12-
LEAD ECG
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
18. WHAT YOU NEED TO LOOK
FOR
Are the limb leads hooked up correctly?
Are the chest leads hooked up correctly?
Is the ECG free of artifact.
Is this ECG a Critical Value
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
19. IS the ECG HOOKED UP
CORRECTLY?
LIMB LEADS
Normal 12-lead
AVR – always
negative
Lead I – always
positive
Lead II, III –
positive or
biphasic
CHEST LEADS
COLUMN III
R wave progression
Small to Tall
COLUMN IV
R wave progression
Tall to Small
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
20. RULING OUT LIMB LEAD
REVERSAL
Avr is always negative
Lead I is always positive
Lead II and III positive for the P wave and usually the
QRS complex
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
21. CHEST LEADS
CHEST LEADS
COLUMN III
R wave progression
Small to Tall
COLUMN IV
R wave progression
Tall to Small
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON
MANGALORE. PH:+919496743672
35. BASIC CRITICAL VALUES
Bradycardia – HR < 40bpm
Tachycardia HR > 120bpm
PVC’s - 4 or more in a row
ST Elevation
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
36. LOOKING AT THE RHYTHM
Evaluate the
rhythm strip at
the bottom of
the 12-lead for
the following
Is the rhythm
regular or
irregular?
Is there a P wave
before every QRS
complex
Are they any
abnormal beats.
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
45. LETS SUMMARIZE
How do we produce an excellent 12-lead ECG?
Proper skin prep
Correct electrode placement
Recognize and know how to correct problems
Recognize basic critical values
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672
Editor's Notes
In an adult with a healthy heart, the heart rate is usually about 72 beats per minute.
The excitatory and electrical conduction system of the heart is responsible for the contraction and relaxation of the heart muscle.
The heart is divided into four chambers, but it functions as a two sided pump.
Top is the right and left atria
Bottom is the right and left ventricles
The right side of the heart receives and pumps venous blood to the lungs.
The left side of the heart receives (from the lungs) and pumps arterial blood to the body.
The sinoatrial node (SA node) is the pacemaker where the electrical impulse is generated. This node is located along the posterior wall of the right atrium right beneath the opening of the superior vena cava. It is crescent shaped and about 3 mm wide and 1 cm long.
The impulse travels from the SA node through the internodal pathways to the atrioventricular node (AV node).
The AV node is responsible for conduction of the impulse from the atria to the ventricles. The impulse is delayed slightly at this point to allow complete emptying of the atria before the ventricles contract. The impulse continues through the AV bundle and down the left and right bundle branches of the Purkinje fibers.
The Purkinje fibers conduct the impulse to all parts of the ventricles, causing contraction (Guyton, 1982).
Lets look at how the conduction system related to what we record on the ECG.
P wave: the sequential activation (depolarization) of the right and left atria
QRS complex: right and left ventricular depolarization (normally the ventricles are activated simultaneously)
ST-T wave ventricular repolarization
U wave: origin for this wave is not clear - but probably represents &quot;afterdepolarizations&quot; in the ventricles PR interval: time interval from onset of atrial depolarization (P wave) to onset of ventricular depolarization (QRS complex)QRS duration: duration of ventricular muscle depolarizationQT interval: duration of ventricular depolarization and repolarizationRR interval: duration of ventricular cardiac cycle (an indicator of ventricular rate)PP interval: duration of atrial cycle (an indicator of atrial rate)
Recorded on graph paper.
Time is measured across
Voltage is measured up and down.
Small squares 1mm high 0.04 secs wide
5 small squares = 1 large square
1 large square is 5mm high and 0.20 sec wide
Both re-usable and disposable electrodes rely on the electrolyte in the electrodes to
make an effective connection between the machines electrode and the patient’s
electro-physiological signals.
These signals are not picked up just off the surface of the skin,
where dead or dry skin, oils and hair all prevent the signals from being detected.
The signals are under this surface, and thus we have to prepare the patient so that
the electrolyte can reach the signals beneath.
This is achieved by:
Removing oil, greasy and dirt from the skins sites with alcohol
ELECTRODE PLACEMENT
The standard 12-Lead ECG is a collect of tracings of electrical activity occurring in the heart. Each lead provides a tracing, which is characteristic of a different view of the same electrical activity. Other words we take 12 different angles (pictures) of the same activity.
In a standard 12-lead ECG there are 6 limb leads with a three-electrode connection made to the Right arm, Left arm and Left leg. The right leg is also hooked up to the machine but this is your ground lead and does not generate a signal on the ECG.
The chest electrodes are labelled “V” and are numbered from 1 to 6.
The placement of these electrodes needs to be exact to give the optimum information as possible. If the electrodes are placed incorrectly on the chest, the tracing will reveal duplication of some information, while other areas will not be represented properly.
Incorrect placement of the electrodes can lead to serious errors of interpretation.
There are six chest leads: V1, V2,V3,V4, V5 and V6.
V1 at the fourth intercostal space, at the right margin of the sternum
V2at the fourth intercostal space, at the left margin of the sternum
V3midway between the position of leads V2 and V4 (in a straight line)
V4at the fifth intercostals space at the junction of the left midclavicular line
V5 midway between the position of leads V4 and V6 (straight down from the axillary
Line on the same horizontal position as V4 and V6
V6at the horizontal position of V4, at the left of the midaxillary line.
Lets look at this ECG for the limb leads?
Is lead I positive? Is AVR negative
We have reversed our limb electrodes we have the right arm on the left arm and reverse.
We need to have R wave progression
In column III the R wave(first positive wave of the QRS) goes from short to tall V1 shortest R wave
V2 R wave taller than in V1 and V3 has the tallest R wave.
In column IV the R wave is always the shortest in V6.
Is this ECG hooked up correctly for the limb leads?
Is it for the chest leads?
Lets evaluate this ECG to see if the Limb leads and Chest Leads are hooked up correctly?
Is this ECG HOOKED UP CORRECTLY FOR LIMB AND CHEST?
Lead I = right arm and left arm
Lead II = right arm and left Leg
Lead III = left arm and Left Leg.
Look at the number of large boxes before two R waves and then using this method find the HR .
I just remember that 2 ½ large boxes or less is critical value for tachycardia
7 or more large boxes is critical for bradycardia
Look at the rhythm strip is it regular or irregular.
How many large boxes are between two R waves = 5 = 60bpm
